Saturday, September 28, 2013

Reaching (or not reaching) breastfeeding goals

There are all sorts of hypotheses for why women don't reach their breastfeeding goals. But I think we have a perfect sample here of educated women who can accurately assess the positives and negatives of breastfeeding.

If you didn't meet your breastfeeding goal, please share with us why not....

I was able to breast feed exclusively (if you count pumping and having baby drink breast milk from bottles at daycare as exclusively breast feeding - which I'm going to) for 6 months. After several long call shifts and trips, we started supplementing with formula at 6 months of age. Considering how demanding my schedule in the OR is, I'm actually quite proud of this.

I met my goals of no formula supplementation for 12 mos with both my boys (exclusively breastfeeding for 6 mos and then adding solids as well). I will say that if I had to choose between pumping or leaving to feed my child and anything at work less urgent than a code blue, I fed the baby and everything else waited. I also had my own office and was able to get a pumping break built into my schedule, in addition to first thing when I arrived in the morning and lunch, so I pumped 3 times between 7am and 4pm.

I'm still pumping and hit 9 months. My goal is to make it to 12 months. I'm an IM resident and thankfully my milk supply is good enough I can pump every 6 hours and still keep up with my LO's needs. Luckily I have an office and several call rooms when I'm not that close to my office and need to be near the ICU/Wards. It's not my favorite times of the day and I long for the day I will stop pumping as my nipples are worse for the wear more so recently. My LO stopped nursing at 7 months as she was already mostly dream feeding by 5 months and with my overnight call schedules, she just drew away from nursing and preferred the bottle. I have to say, I'm also proud I've made it this far as I was counseled early on by my program director that she would be surprised if I didn't have to supplement with formula shortly after returning to residency because she didn't think my schedule and pumping would work out which was disheartening at first but then I quickly realized I could make it work and have been pumping along ever since.

I planned to do 12 mos with my first, but she self-weaned suddenly at 11 mos. I was a chief resident at the time, so had a lighter clinical load than residency, which helped. I pumped & gave breast milk by bottle for 12 mos with my 2nd. She has congenital heart disease & needed a lot of extra calories from fortified milk so we could never do just plan breast milk. Pumping for that long was horrible, but I felt like it was something I could do that might help balance out all that hadn't gone right for her. So I just get plugging along. Fenugreek & blessed thistle kept me going. Whenever I had a string of shifts where I couldn't get out of the ER to pump or I was super stressed & my milk started decreasing, I'd take both of them for a couple weeks until milk production was better. Couldn't have made it without them.

Hi, I started taking Fenugreek to see if it would help increase my supply but I'm not sure if it's sitting well in my baby's tummy. He seems to vomit either right after he feeds or 5mins after. I don't know if it's because of the Fenugreek or if he just has bad reflux. So I stopped using it. Did you have any bad experiences with Fenugreek?

I wanted to breast feed for as long as my kid wanted to. My milk didn't come in until day 10 - my baby was jaundiced, volume depleted and lost nearly 20% of her birth weight. So we had to supplement. When my milk finally came in it was never enough for her even thoughI was feeding q2h, pumping after every feed, drinking gallons of water. I stank to high heavens thanks to my fistfuls of fenugreek and thistle I crammed in 4x/day. I went back to work as an IM resident after 6 weeks and went straight into 2 months of call. Pumping during the day essentially added 2 hours onto my work day meaning I was going days and days without seeing my daughter - leaving at 6 am and coming home after she was asleep (all so I could bring home 4oz of milk total).

So I quit. Can you tell I'm still bitter? Mostly it was the post-partum nurse who scolded me when I asked on my day of discharge what I should do if my milk didn't come in. "It always comes in, don't give her formula, don't you want the best for your baby?".......

I managed to avoid formula entirely and breastfed until my daughter self-weaned at around 15 months. I was writing my dissertation and was able to tie myself to the pump for hours each day. Pumping was truly awful and if I had to do it over again, I'd strongly consider supplementing earlier on so that I wouldn't have to be tied to that godforsaken instrument of torture for 12 freaking months.

I tried to nurse- but there was NO WAY my daughter was going to work hard enough to get the milk from me. I wanted to nurse so badly. I cried, she screamed, the lactation consultant tried contraptions and pillows, and feet tickling, and nipple guards, and the end result would be frustration, exhaustion, and a cranky, hungry baby. When she failed to gain an ounce after 2 weeks post-birth, despite alternating feedings with nurse-attempts (failures) and pumped bottle feeds, I switched to exclusively bottle feeding with pumped breast milk. I had a great milk supply, but after 6 weeks of basically being plugged in all day, playing feeding catch up, I couldn't do it anymore.I started med school 10 weeks after she was born, so while I had enough breast milk frozen to get her to 8 weeks, we switched to formula once the little medela bags were used up. Again, I cried, but she was the happiest little girl and the guilt dissipated (mostly) pretty quickly. (I still get twangs of regret when I see my friends successfully and happy breastfeeding their 9 month olds.)

I made it until 4 months with a combination of breast and bottlefeeding. Then I did an ED rotation an hour and a half from home. I hated to give it up, but between the 12 hour shifts and the drive it just wasn't possible.

I made it until 4 months with a combination of breast and bottlefeeding. Then I did an ED rotation an hour and a half from home. I hated to give it up, but between the 12 hour shifts and the drive it just wasn't possible.

I graduated and took 10 mo off with my first, and BF was great. When I went back to work part time I pumped twice a day and we went to 15 mo before she suddenly self-weaned. I returned to part time work at 6 weeks with the second baby, and it was much harder. My production always seemed low despite herbal supplements and extra pumping. I fretted because she was in the 20th percentile (my first baby was huge!) and always felt I wasn't doing enough. The second baby self weaned at 14 months, likely because after I stopped pumping at 12 months my milk supply disappeared. Even with a PT schedule I was stressed over it, but I don't regret it. After this next baby arrives, we'll go as long as he/she wants and afterwards I'm punting that pump off a cliff!

I was aiming for 6 months exclusively breastfeeding and up to 2 years with complementary feeding (breastfeeding and solids). I was able to do it with good lactation support, a great pediatrician, supportive family, a good pump, commitment and a little bit of luck.

This is such an important topic, especially for mothers in the medical field. We need to prioritize helping ourselves and our peers be able to maintain a good breastfeeding relationship if we expect our patients to be able to.

I BF exclusively until 6 months, added solids, and then had to stop BF abruptly at 13 months because radiology residents have the pleasure of going to a month-long course in DC during third year. I met my goal of never having to supplement for as long as I could BF, but it was exhausting to pump for that long. I set my goals in 3-month increments (hoping desperately to make it to at least 6), so I'm glad we got as far as we did. I do wish we could have gone further, but I also suspect that my child would have self-weaned anyway, if I hadn't stopped abruptly when I did. I'm in a very supportive residency. I have no idea how other women do this if their schedules aren't as flexible as mine. I was doing some pretty crazy things too (pumping while driving, waking up to pump even after my kid started sleeping through the night, etc). I've heard of women pumping with covers on ICU rounds, so I guess I'm not the most desperate mom out there.

I started back on my rotations a month ago so far I have been able to manage pumping breaks every 5-6hours and my milk supply has been good enough to replenish what is used that day. I start my medicine subI on Tuesday and I am hoping to at least have enough time to pump at least 5-6hour intervals. I know it won't be easy but if I make it through this month, the rest of my MS4 year should be a bit more manageable to continue exclusively breast feeding.

I had issues right away as my daughter was over 9 lbs and hypoglycemic after birth. She did NOT take to breastfeeding well at first, as each feeding was an exercise in frustration for all of us. However, after 2 weeks we finally got the latch, etc. and I would BF then supplement. By 2 months she exclusively BF (albeit for just one week - while I was on vacation - because my pumping was always crummy - very low volume). I did keep up with the pumping & BF until 10 months when she bit my boob and that was it for me! I went back to work when she was 6 weeks old, and in retrospect, I wish I had gone to straight formula much earlier and used some of my precious energy for other mothering activities, or even just sleep, as I had quite a round of postpartum depression. I encourage all my patients to breastfeed, but I'm certainly not militant about it because I think formula is a reasonable option. When your resources (time, energy, support) are low, IMHO sometimes it's better not to completely exhaust yourself with the breastfeeding.

I just never made enough with my first. I supplemented the whole time for the first year. We breastfed until 18 months when he and I both decided to wean. I am happy to say, I exclusively breastfed my second, and we are still feeding a few times a day at 19 months. I pumped on my commute, between cases, during lunch, and more. Stressful, but I made it work :)

A great topic for discussion! I always imagined I would exclusively breastfeed. Then my daughter was born at 9lbs 5ozs with a blood sugar of 16, so she was given formula within the first hour of life. I was anemic with a Hgb of 7 and my milk took over a week to come in. I drove myself crazy worrying and trying to latch her when she had given up on my empty boobs. I was up pumping every two hours, losing out on what little sleep might have been possible. Multiple lactation consultants told me not to give her a bottle, ever. Then day five came around and my daughter screamed for 14 hours straight. My partner went out and bought some formula and she took three ounces and settled into a satisfied sleep. I found an amazing lactation consultant who didn't have an agenda and helped me to achieve my goal at that point, which was for my daughter to get some breastmilk. For the first few months, she would breastfeed, then get a bottle of formula or breastmilk, then I would pump -- 1.5 hours of feeding-related activities every 2-3 hours. My supply was never enough to meet her needs: never more than 2 ounces total per 20 minute pumping session. We got to six months then the first day of intern year came and I didn't produce any milk at all for the first time. I decided to devote the time and energy I was giving to pumping and sterilizing tubing to my child instead, realizing that time would be scarce (I wrote about this difficult decision at the time: http://whatbeginswithm.wordpress.com/2012/06/20/good-to-the-last-drop).

I will always feel resentful about the amount of guilt and emotional pain I carried with me over my low supply, not to mention the first five hungry days of my daughter's life. I wish I had been able to jettison the breastfeeding hype and focus on the situation at hand. I was a little slower in gaining confidence as a mother than I expected and I think the breastfeeding struggle was largely to blame. I wonder how many cases of postpartum depression are exacerbated by the pressure to breastfeed. As a pediatrician, I advocate for breastfeeding and try to be supportive of breastfeeding mothers, but I am careful to create space for mothers who are struggling or can't breastfeed for whatever reason. We have to remember that breastfeeding does not equal love. It is a way to feed your baby that is optimal under ideal circumstances, but it is not the be all and end all of parental accomplishment. If I had it to do all over again, I would have spent a lot less time agonizing over breastfeeding and a lot more time bonding with and enjoying my daughter in her first months.

My goal (based on the literature) was to breastfeed for some period of time. I breast fed for 6 months. She was ready to stop and that was that. She started getting 4 oz of formula (fed to her by dad) at 1 month at the advice of our pediatrician (as he said, for the inevitable day when there is a supply and demand mismatch so she'll take formula, and so dad had something more fun to do than change diapers; and yes, I was very grateful to have such a practical and rational pediatrician). We started her on solids at 4 months because she was hungry. She's hardly ever been sick, now in high school, 6 feet tall and still growing. I'm glad we did what worked for us and ignored all the mommy-shaming opportunities.

I exclusively breastfed for 6 months with my first and supplemented after that. We continued to nurse part-time (night and weekends mostly) till nine months. With my second daughter I just couldn't keep up with the pumping. With work and chasing after a toddler it was impossible to find time to pump enough, so I started supplementing at 3 months. She's 7 months and we are enjoying the part time nursing. She is my last baby, so hopefully we can carry on like this until she's 12 months.

I didn't get to my goal to exclusively breast feed for 6 months. There was the plot twist of post-partum depression. Stopping breastfeeding helped the depression ebb. It was better for my daughter to have a sane mom, than to worry about the breast milk vs formula war. I still pumped for 8 months, so she had some breast milk up until then. Though with pumping, it was hard to keep any substantial level up.

I exclusively breast fed my son for 3 months until i went back to work. At that time I pumped every day so he would drink the milk pumped the day before while i was at work the next day. We managed that somehow until 6 months and then he had formula and cereal but kept bf for morning and night snuggle feedings. Those went on until he was a year at which point I weaned him (quite easily) as I was still not menstruating (what a nice break that was!) and we wanted to get pregnant again.

It was pretty stressful trying to pump at work, both trying to fit it in and find a suitable place. I'm in a surgical subspecialty so with long cases I was sometimes very uncomfortable by the end and sometimes would have quite a bit of leakage on the scrubs despite breast pads. This means I would keep my lead apron on until the very last second before I ran out of the room. Good times. But worth it.

I just had my second baby. I'm planning exclusive bf for 6 months as I have a longer maternity leave this time.

I love breastfeeding and feel like it is the most special of bonding times. But I also agree with disagreeing with the guilt and pressure that is placed on all women to breastfeed regardless of their personal circumstances. That's not fair.

Going back to work early (6 weeks) and being in residency with little time to pump hurt my supply so I did have to supplement with my first but still reached my goal of continuing to breastfeed and provide (mostly) breastmilk at daycare for one year.

I felt great about that in the end but battled mommy guilt in the beginning. I think my lactation consultant training made me feel more guilt about what I couldn't do!!

On my third child and with a longer maternity leave, I already notice a better supply. And, I learned to let go of the guilt a long time ago and feel proud for what I CAN do - which is what I now tell my patients. I know I will have to supplement some because it's just hard to pump enough at work. But, I plan to keep on until one year at least. And for that, I am happy!

Mothers in Medicine is a group blog by physician-mothers, writing about the unique challenges and joys of tending to two distinct patient populations, both of whom can be quite demanding. We are on call every. single. day.

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